Post macula off retinal detachment... now need cataract surgery

[Root710]

I had a retinal detachment that involved a couple of major tears and silicone oil placement after vitrectomy.  The oil has since been removed except a few small irritating droplets and I now require cataract surgery.  My sight in this eye is around 20/50-20/60 with new spectacles.  I have developed dry eye and the vision varies slightly because of this from day to day.  The glare from the cataract is significant and also interferes with acuity.  My retinal specialist said I will probably improve by a couple lines of resolution on the eye chart after cataract surgery.  He wants me to get a monofocal IOL and avoid multifocal or accomodating lens because of decreased contrast and halos, etc.  I am fine with that but want to maximize my visual acuity in any way possible.  
I’ve seen 2 cataract surgeons with different opinions.  One recommends the ZCB00 aspheric tecnis lens.  The other recommends the Bausch and Lomb Envista which is aspheric and has no glistenings.  He says that my cornea has a negative optical aberration profile and the Envista has a neutral amount of optical aberration.  This would help my depth of focus.  While the tecnis lens has a negative optical aberration and would cause my negative aberration to be -.50 which would decrease my depth of field.  He also uses the femtosecond laser where the first surgeon is completely manual.  He didn’t even consider the amount of aberration my cornea had and when asked didn’t recall what amount I have and didn’t think it was important.  This kind of scared me.  Can anyone make recommendations about this?
Also, I was wondered if the LALRx lens would be of any use because it can be adjusted to a range of focusing distances like a multifocal but without the steps that cause the artifacts and the decreased contrast sensitivity. I thought the EDOF lens might be an option but was told it also decreases contrast (although not as much) and it makes it more difficult to visualize the retina.  I thought that extending the depth of field would help smooth out the irregularities in my retina and help get me clearer vision.  Indepenance from spectacles is not really that important to me.  Although if I did regain good distant vision in this eye, I might consider a monovision option.
Please help with your input.  Thank you!!

[John C Hagan III, MD, FACS, FAAO]

First read this article thoroughly:  
http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

There is no "best IOL"  every IOL maker states they have the best, no different from every car maker. But there are lots of good automobiles and no "best" one.  Same way with IOLs. My wife had cataract surgery this past year and had Tecnis AZ9003 and is delighted. You really can't make a bad choice.  

Be careful of surgical offices that try and "up-sell" all the IOL surgery options.  They are in every city, we have a number in Kansas City.  The entire staff is encouraged, even given bonuses' to have patients spend extra out of pocket money on: "premium IOLs (toric, multifocal, accommodating, now light adjusted), femtosecond laser, ORA technology    NONE OF THESE HAVE BEEN SHONE TO IMPROVE PATIENT SAFETY AND OFFER MAJOR ADVANTAGES OVER A HIGH QUALITY MONOFOCAL IOL.   Almost all modern monofocal IOLs are aspherical. The toric IOL is relatively inexpensive and offers advantages for people with corneal astigmatism over a diopter who are willing to pay extra and accept a 1.5-3% chance of need a second operation to realign the toric IOL.

I recently saw in as a second opinion a patient in Kansas City that has spent $7500 PER EYE for all the bells and all the whistles and who stated he would not need glasses for anything.  He did need glasses and was very unhappy and much poorer.    Theses offices are VERY HIGH PRESSURE, they make you feel like a standard spheric monofocal IOL is 'not good enough for your eye".    There are many seminar's and workshops that are all about how to sell people of upgrading.  

Last statement THERE IS NO "BEST" IOL.

[Root710]

Sorry, it appears you misunderstood my question. I did not ask “what is the best IOL”.
I explained my particular situation and the monofocal lenses that were recommended for me.  Nothing about up-selling.  I’m trying to ascertain if one lens is better for my situation because of my negative corneal aberration. (I believe a positive corneal SO is more common).  I know some people don’t care about higher order aberrations because their effects are small.  I am detail oriented and want to be left with the best vision that I can get, even in light of my detached retina history.  I feel that some slight extra depth of focus may help my situation.  My other question is whether or not there are any accomodating lenses or others that would help.  I know that the pat answer is that my vision is compromised and there is no point in spending more on fancy lenses.  By the way nobody has tried to up-sell me to one of these.
Any constructive information about my actual question would be appreciated.

[Root710]

That was supposed to be SA (spherical aberration). Darn spell check.

[John C Hagan III, MD, FACS, FAAO]

Because you had a macula off RD it is unlikely that your vision would be corrected to 20/20 even with glasses and even with no cataract. Moreover if you will read the many posts including Mr. Presley you will see that even the lucky few that do see 20/20 to 20/230 post mac off RD have distortion and things look bigger or smaller than they should.  Most retina and cataract surgeons would not implant any accommodating/refractive, extended focus like Symfony.   Some would not even suggest toric.   The great majority including what I do in my practice is suggest a aspheric monofocial.  That being said our practice use Tecnis IOLs.  I have no experience with B&L  IOL.  Their IOLs are okay but not the leaders in IOL technology.   Our practice did some of the investigational  FDA research on light adjustable IOLs. Not a good choice for you.  

[pinhole]

My experience as a patient: I had the tecnis ZA9003 put in my macula-off RD eye (treated with vit-buckle) at the same time as an ERM peel was done. Corrected vision (eyeglasses) is 20/20. Other eye, also post-RD, has the tecnis ZCB00. I could have had a toric in that eye, but I didn't want to introduce extra factors into the surgery.

[John C Hagan III, MD, FACS, FAAO]

Thanks for adding your experience. You are extraordinarily fortunate and a testament to modern vitreo/macula/retina/cataract surgery.  

[MrPresley]

Excellent outcome @pinhole. The IOL in my operative LE was done about 18 months post-virectomy ERM peel. Monofocal, in approximate parity with my thus far non-operative RE, and 20/15 corrected vision in my operative eye using contacts. As Dr. Hagan posted, modern medicine can be truly marvelous.

[John C Hagan III, MD, FACS, FAAO]

Amen